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Kyphosis () is an abnormally excessive convex curvature of the spine as it occurs in the
thoracic The thorax (: thoraces or thoraxes) or chest is a part of the anatomy of mammals and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main ...
and sacral regions. Abnormal inward concave ''lordotic'' curving of the cervical and
lumbar In tetrapod anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm (anatomy), diaphragm and the sacrum. Naming and location The lumbar region is sometimes referred to as the lowe ...
regions of the spine is called lordosis. It can result from
degenerative disc disease Degenerative disc disease (DDD) is a medical condition typically brought on by the aging process in which there are anatomic changes and possibly a loss of function of one or more intervertebral discs of the vertebral column, spine. DDD can take ...
; developmental abnormalities, most commonly Scheuermann's disease; Copenhagen disease,
osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk. It is the most common reason f ...
with compression fractures of the
vertebra Each vertebra (: vertebrae) is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spina ...
;
multiple myeloma Multiple myeloma (MM), also known as plasma cell myeloma and simply myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibody, antibodies. Often, no symptoms are noticed initially. As it progresses, bone ...
; or trauma. A normal thoracic spine extends from the 1st thoracic to the 12th thoracic vertebra and should have a slight kyphotic angle, ranging from 20° to 45°. When the "roundness" of the upper spine increases past 45° it is called kyphosis or "hyperkyphosis". Scheuermann's kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females. In the sense of a deformity, it is the pathological curving of the spine, where parts of the spinal column lose some or all of their lordotic profile. This causes a bowing of the
back The human back, also called the dorsum (: dorsa), is the large posterior area of the human body, rising from the top of the buttocks to the back of the neck. It is the surface of the body opposite from the chest and the abdomen. The vertebral c ...
, seen as a slouching posture. Kyphosis is distinguished from
scoliosis Scoliosis (: scolioses) is a condition in which a person's Vertebral column, spine has an irregular curve in the coronal plane. The curve is usually S- or C-shaped over three dimensions. In some, the degree of curve is stable, while in others ...
, a condition in which the spine has a sideways curve. While most cases of kyphosis are mild and only require routine monitoring, serious cases can be debilitating. High degrees of kyphosis can cause severe pain and discomfort, breathing and digestion difficulties,
cardiovascular In vertebrates, the circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the body. It includes the cardiovascular system, or vascular system, that consists of the heart a ...
irregularities,
neurological Neurology (from , "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the s ...
compromise and, in the more severe cases, significantly shortened life spans. These types of high-end curves typically do not respond well to conservative treatment and almost always warrant
spinal fusion Spinal fusion, also called spondylodesis or spondylosyndesis, is a surgery performed by Orthopedic surgery#Practice, orthopaedic surgeons or neurosurgeons that joins two or more vertebrae. This procedure can be performed at any level in the spine ...
surgery, which can restore the body's natural degree of curvature.


Signs and symptoms


Complications

The risk of serious complications from spinal fusion surgery for kyphosis is estimated to be 5%, similar to the risks of surgery for
scoliosis Scoliosis (: scolioses) is a condition in which a person's Vertebral column, spine has an irregular curve in the coronal plane. The curve is usually S- or C-shaped over three dimensions. In some, the degree of curve is stable, while in others ...
. Possible complications include inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding, and nerve injuries. According to the latest evidence, the actual rate of complications may be substantially higher. Even among those who do not develop serious complications, 5% of patients require reoperation within five years of the procedure, and in general it is not yet clear what one would expect from spine surgery during the long-term. Given that the signs and symptoms of spinal deformity cannot be changed by surgical intervention, surgery remains essentially a cosmetic choice. However, the cosmetic effects of surgery are not necessarily stable.


Diagnosis


Classification

There are several kinds of kyphosis (
ICD-10 ICD-10 is the 10th revision of the International Classification of Diseases (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social cir ...
codes are provided): * Postural kyphosis (M40.0), the most common type, normally attributed to slouching, can occur in both the old and the young. In the young, it can be called "slouching" and is reversible by correcting muscular imbalances. In the old, it may be a case of hyperkyphosis and called "dowager's hump". About one third of the most severe hyperkyphosis cases in older people have vertebral fractures. Otherwise, the aging body does tend towards a loss of musculoskeletal integrity, and hyperkyphosis can develop due to aging alone. * Scheuermann's kyphosis (M42.0) is significantly worse cosmetically and can cause varying degrees of pain, and can also affect different areas of the spine (the most common being the midthoracic area). Scheuermann's kyphosis is considered a form of juvenile osteochondrosis of the spine and is more commonly called Scheuermann's disease. It is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. A patient with Scheuermann's kyphosis cannot consciously correct posture. The apex of the curve, located in the
thoracic vertebrae In vertebrates, thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. In humans, there are twelve thoracic vertebra (anatomy), vertebrae of intermediate size between the ce ...
, is quite rigid. The patient may feel pain at this apex, which can be aggravated by physical activity and by long periods of standing or sitting. This can have a significantly detrimental effect on their lives, as their level of activity is curbed by their condition; they may feel isolated or uneasy amongst peers if they are children, depending on the level of deformity. Whereas in postural kyphosis, the vertebrae and discs appear normal, in Scheuermann's kyphosis, they are irregular, often herniated, and wedge-shaped over at least three adjacent levels.
Fatigue Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself. Fatigue (in the medical sense) is sometimes associated wit ...
is a very common symptom, most likely because of the intense muscle work that has to be put into standing or sitting properly. The condition appears to run in families. Most patients who undergo surgery to correct their kyphosis have Scheuermann's disease. * Congenital kyphosis (Q76.4) can result in infants whose spinal column has not developed correctly in the womb. Vertebrae may be malformed or fused together and can cause further progressive kyphosis as the child develops. Surgical treatment may be necessary at a very early stage and can help maintain a normal curve in coordination with consistent follow-ups to monitor changes. However, the decision to carry out the procedure can be very difficult due to the potential risks to the child. A congenital kyphosis can also suddenly appear in the teenage years, more commonly in children with cerebral palsy and other neurological disorders. * Nutritional kyphosis can result from nutritional deficiencies, especially during childhood, such as vitamin D deficiency (producing
rickets Rickets, scientific nomenclature: rachitis (from Greek , meaning 'in or of the spine'), is a condition that results in weak or soft bones in children and may have either dietary deficiency or genetic causes. Symptoms include bowed legs, stun ...
), which softens bones and results in the curving of the spine and limbs under the child's body weight. * Gibbus deformity is a form of structural kyphosis, often a ''sequela'' to
tuberculosis Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can al ...
. * Post-traumatic kyphosis (M84.0) can arise from untreated or ineffectively treated vertebral fractures.


Grading

Kyphosis can be graded in severity by the Cobb angle. Also, ''sagittal balance'' can be measured. The sagittal balance is the horizontal distance between the center of C7 and the superior-posterior border of the endplate of S1 on a lateral radiograph.


Treatments

A diagnosis of kyphosis is generally made through observation and measurement. Idiopathic causes, such as vertebral wedging or other abnormalities, can be confirmed through X-ray. Osteoporosis, a potential cause of kyphosis, can be confirmed with a
bone density Bone density, or bone mineral density, is the amount of bone mineral in bone tissue. The concept is of mass of mineral per volume of bone (relating to density in the physics sense), although medicine#Clinical practice, clinically it is measured by ...
scan. Postural thoracic kyphosis can often be treated with posture reeducation and focused strengthening exercises. Idiopathic thoracic kyphosis due to vertebral wedging, fractures, or vertebral abnormalities is more difficult to manage, since assuming a correct posture may not be possible with structural changes in the vertebrae. Children who have not completed their growth may show long-lasting improvements with bracing. Exercises may be prescribed to alleviate discomfort associated with overstretched back muscles. A variety of gravity-assisted positions or gentle traction can minimize pain associated with nerve root impingement. Surgery may be recommended for severe
idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin. For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of people with the condition, the cause ...
kyphosis.


Brace

Body braces showed benefit in a randomised controlled trial. The Milwaukee brace is one particular body brace that is often used to treat kyphosis in the US. Modern CAD/CAM braces are used in Europe to treat different types of kyphosis. These are much easier to wear and have better in-brace corrections than reported for the Milwaukee brace. Since there are different curve patterns (
thoracic The thorax (: thoraces or thoraxes) or chest is a part of the anatomy of mammals and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main ...
, thoracolumbar, and
lumbar In tetrapod anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm (anatomy), diaphragm and the sacrum. Naming and location The lumbar region is sometimes referred to as the lowe ...
), different types of brace are in use, with different advantages and disadvantages. Image:kyphosis brace1.jpg, Modern brace for the treatment of a thoracic kyphosis. The brace is constructed using a CAD/CAM device. Image:kyphosis brace 3.jpg, Modern brace for the treatment of lumbar or thoracolumbar kyphosis. The brace is constructed using a CAD/CAM device. Restoration of the lumbar lordosis is the main aim.


Physical therapy

In Germany, a standard treatment for both Scheuermann's disease and lumbar kyphosis is the Schroth method, a system of physical therapy for scoliosis and related spinal deformities. It involves lying supine, placing a pillow under the scapular region and posteriorly stretching the cervical spine. In China, many people use spinal care mattresses to correct kyphosis while sleeping.


Surgery

Surgical treatment can be used in severe cases. In patients with progressive kyphotic deformity due to vertebral collapse, a procedure called a kyphoplasty may arrest the deformity and relieve the pain. Kyphoplasty is a minimally invasive procedure, requiring only a small opening in the skin. The main goal is to return the damaged vertebra as close as possible to its original height.


Society and culture


People affected by condition

* Åžehzade Cihangir * Nicolas Ferry * Godfrey IV, Duke of Lower Lorraine *
Topper Headon Nicholas Bowen "Topper" Headon (born 30 May 1955) is an English drummer and multi-instrumentalist, best known as the drummer of punk rock band the Clash. Headon was inducted in the Rock and Roll Hall of Fame with the rest of the Clash in 2003. ...
* Inge the Hunchback * Konrad II the Hunchback * Benjamin Lay *
Georg Christoph Lichtenberg Georg Christoph Lichtenberg (; 1 July 1742 – 24 February 1799) was a German physicist, satirist, and Anglophile. He was the first person in Germany to hold a professorship explicitly dedicated to experimental physics. He is remembered for his p ...
* Louis the Hunchback * Mahmud I * Margaret of Bavaria (1442–1479) *
Pepin the Hunchback Pepin (or Pippin) the Hunchback (, ; 768/769 – 811) was a Franks, Frankish prince. He was the eldest son of Charlemagne and noblewoman Himiltrude. He developed a kyphosis, humped back after birth, leading early medieval historians to give him ...
* Charles Proteus Steinmetz * Władysław the Hunchback


Popular culture

One of the most well-known and enduring depictions of kyphosis is Quasimodo, the eponymous hero of
Victor Hugo Victor-Marie Hugo, vicomte Hugo (; 26 February 1802 – 22 May 1885) was a French Romanticism, Romantic author, poet, essayist, playwright, journalist, human rights activist and politician. His most famous works are the novels ''The Hunchbac ...
's 1831 novel '' The Hunchback of Notre-Dame'', which solidified the popular conception of the hunchback as a destitute and pitiable outcast from European society. The legendary Comprachicos of the sort popularized in Hugo's similar work '' The Man Who Laughs'' are instead described as being able to turn able-bodied young children into hunchbacks, alongside a variety of other deformities, using poisons and mutilation, before selling their results into bondage as court dwarfs or
freak show A freak show is an exhibition of biological rarities, referred to in popular culture as "Freak, freaks of nature". Typical features would be physically unusual Human#Anatomy and physiology, humans, such as those uncommonly large or small, t ...
performers. Early
horror film Horror is a film genre that seeks to elicit physical or psychological fear in its viewers. Horror films often explore dark subject matter and may deal with Transgressive art, transgressive topics or themes. Broad elements of the genre include Mo ...
s developed the hunchbacked Igor as a
stock character A stock character, also known as a character archetype, is a type of character in a narrative (e.g. a novel, play, television show, or film) whom audiences recognize across many narratives or as part of a storytelling tradition or convention. Th ...
assistant to a
mad scientist The mad scientist (also mad doctor or mad professor) is a stock character of a scientist who is perceived as "mad, bad and dangerous to know" or "insanity, insane" owing to a combination of unusual or unsettling personality traits and the unabas ...
.


See also

* Bethlem myopathy 2 * Ehlers–Danlos syndrome * Copenhagen disease * Loeys–Dietz syndrome *
Pott disease Pott's disease, or Pott disease, named for British surgeon Percivall Pott who first described the symptoms in 1799, is tuberculosis of the vertebral column, spine, usually due to haematogenous spread from other sites, often the lungs. The lowe ...


References


External links


Kypho
definition and other related medical terms {{Congenital malformations and deformations of musculoskeletal system Congenital disorders of musculoskeletal system Deforming dorsopathies External signs of ageing